Partnerships, people and place – the NHS 2020 vision

Seismic shifts that will place increasing emphasis on local delivery, partnership and health as a driver of economic growth will be key characteristics of public services in the years to 2020, says Rob Webster, CEO of the NHS Confederation.

Rob Webster joined the NHS Confederation as Chief Executive in February 2014. The NHS Confederation represents NHS organisations at governmental and union level. Rob is also a Visiting Professor at Leeds Beckett University and Fellow of the Queen’s Nursing Institute.

Over the next five years we will see some seismic shifts in the public sector. The evidence points to a continued reduction in public spending up to 2020, although the NHS will be protected and I expect to see some growth.

We are also likely to see a much greater consolidation of public services around ‘place’. People are really visible in issues like devolution, but it’s a sign of a greater ‘place’ agenda, and of the importance of community-level planning. As a result, there will be greater emphasis on how public services are delivered to people where they live – because that’s where people feel a connection.

Additionally, as a sector we need to view people as assets, not issues to be dealt with. Within the NHS a lot of time is spent on ongoing care, long-term condition management and frailty. We can help people to use their assets to support and look after themselves and that’s going to be a big area of focus.

Setting standards

The other seismic shift will be in standardisation and transparency. We need clearer standards. The NHS and public services have degrees of variation in standards that are unacceptable. Looking ahead, we'll be much clearer about the expectations that we have, about what we're achieving, and what the outcomes are for local people. How these are benchmarked will help to drive change, and that will impact service delivery and supply chain management.

International opportunity

The health agenda is set for growth. The International Monetary Fund (IMF), for example, expects developed nations to increase their expenditure on health overall by up to around 1-3% of their GDP every decade. In the UK, the majority of that spend comes from the public purse. Where the opportunity lies is in seeing health as an economic driver. In many areas we’re doing it already through local enterprise, partnerships and local growth strategies.

Where there’s real opportunity is at an international level. Other developed nations are facing the same issues as we are when it comes to public services and healthcare. If we can prove that we have solutions to issues like frailty, support for the elderly and digitalisation, then we can generate significant investment from overseas.

We have some of the brightest people on the planet working in the NHS and our academic institutions. Within industry, digital and medical technology we have some of the most entrepreneurial. We've got to exploit that.

Where to focus

Being the public sector, there’s always a huge political agenda, so managing the politics at a local and national level will continue to be important. In order to deal with the issues around place, standardisation and funding, organisations need to really start looking now at the relationships that exist within the areas they operate.

"We need to view people as assets, not issues to be dealt with."

The first focus needs to be on staff investment. We’re going to see huge changes in the way staff in public services work and organisations need to invest in changing fixed views and maximising the brightest and best people. It’s something we’re investing in at the NHS Confederation. In such a rapidly-changing context, if you don’t keep pace you become redundant. To guard against that, we’re looking at our skills and capacity to deliver, at the commercial skills we’ll need to engage, and at the opportunities that will help us drive the leadership of the NHS.

Embracing innovation

Communication is key. The public sector needs to not only embrace innovation, but ensure that these digital innovations are shared. This is an area that the NHS in particular needs to act on. We shouldn’t, for example, still be communicating largely by letter and fax. By using technology we can become more efficient, delivering unprecedented levels of sustained improvements and productivity gains.

By doing things completely differently, by changing the way we deliver care, we will see a big difference.

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